CROI 2025 Abstract eBook

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Poster Abstracts

1137 Vaginal and Anal Intercourse With Women Reported by Men Who Have Sex With Men, 2015-2019 Katrina M. Byrd, Weiming Zhu, Wei Wei, Ya-Lin A. Huang, Karen W. Hoover Centers for Disease Control and Prevention, Atlanta, GA, USA Background: In 2022, 18% of new HIV diagnoses were in heterosexual women in the United States. Most women (83%) acquired HIV from heterosexual contact. In contrast, male-to-male sexual contact was the most common mode of HIV transmission in men (89%). HIV preexposure prophylaxis (PrEP) reduces the risk of sexual HIV transmission by ~99% but only 8% of PrEP users were female compared to males (92%). Our objective was to estimate proportions of men who have sex with men (MSM) who reported anal or vaginal sex with a woman in the last 12 months. Methods: We analyzed data from the 2015-2017 and 2017-2019 National Survey of Family Growth (NSFG) to estimate the number of sexually active US men aged 15-49 years. We categorized sexually active men as “MSM” if they reported ever having oral or anal sex with a man and as “heterosexual” if they did not report sex with a man. Men were considered sexually active if they had oral, vaginal, or anal sexual intercourse with same or opposite sex partners within the last 12 months. All estimates were weighted to be nationally representative. The Chi-square test was used to determine statistical significance. Results: Between 2015-2019, 4.1 million of 59.8 million sexually active males were classified as MSM. Of which, 2.1 million MSM reported sexual intercourse with a female partner in the last 12 months. Vaginal sex was the most frequent sexual behavior with women reported by both MSM (98.4%) and heterosexual men (95.3%). Conversely, anal sex was the least frequent sexual behavior type with women reported by MSM (34.4%) and heterosexual men (21.4%). A significantly higher proportion of MSM reported anal sex with women in the last 12 months compared to heterosexual men (p < 0.001). About 15.0% of MSM had both male and female partners, and 5.0% of MSM had anal sex with both male and female partners in the past 12 months. Conclusions: Half of men who engaged in male-to-male sexual contact had vaginal and/or anal intercourse with a woman in the last 12 months. MSM reported a higher proportion of anal sex with female partners compared with heterosexual men. These findings stress the importance of asking women about their partners' male-to-male sexual contact history and their behaviors associated with HIV transmission such as anal intercourse. Given low PrEP uptake in women, this information can prompt providers to offer PrEP and other HIV prevention strategies to women who might otherwise be at low risk for HIV acquisition.

1136 C-Reactive Protein as a Predictor of Hospitalization and Mortality in Advanced HIV Disease in Uganda Elizabeth L. Schwartz 1 , Ann M. Fieberg 1 , Biyue Dai 1 , Caleb Skipper 1 , David R. Boulware 1 , David B. Meya 2 , Elizabeth K. Nalintya 3 , Radha Rajasingham 1 , for the ENCORE Team 1 University of Minnesota, Minneapolis, MN, USA, 2 Infectious Diseases Institute, Kampala, Uganda, 3 Makerere University College of Health Sciences, Kampala, Uganda Background: People with advanced HIV disease (AHD) remain at high risk for opportunistic infections, hospitalization, and death, despite improved access to antiretroviral therapy (ART). We aimed to evaluate the predictive value of serum C-reactive protein (CRP) for the detection of future hospitalization or death among outpatients with AHD in Uganda. Methods: Serum CRP values were collected prospectively from 759 participants enrolled in the ENCORE trial (NCT05085171), a community-based cluster randomized trial in adults with AHD (baseline CD4 <200 cells/µL). Participants were recruited from May 5, 2022 to February 8, 2024 at outpatient clinics in the Kampala and Wakiso districts of Uganda. We examined baseline CRP as both a continuous predictor and as a dichotomized predictor at a threshold of 10mg/L. We used logistic regression and Cox regression models to assess CRP as a risk factor for hospitalization or death. We calculated the area under the receiver operating characteristic curve (AUC) to evaluate CRP as an independent predictor for 30-day hospitalization-free survival. Results: A CRP threshold of 10 mg/L was identified as a strong predictor of 30-day hospitalization or death. In our cohort, 41% had an elevated CRP value (>10mg/L). Participants with elevated CRP were significantly more likely to be hospitalized (Relative Risk=3.18, p=0.002) or die (Relative Risk=8.60, p<0.001) within 30 days of enrollment. When controlling for potential confounding variables of sex, age, weight, CD4 count, and ART status in a multivariate Cox proportional hazards model, the hazard of hospitalization or death within 30 days increased by 32% (HR=1.32, p<0.001) for each doubling of CRP ( Table 1 ). When examining the composite outcome of 30-day mortality or hospitalization, CRP has an AUC of 0.76 as a univariate continuous predictor, and the multivariate model performed significantly better when CRP was included (AUC=0.80), compared to when CRP was excluded from the model (AUC=0.73). Conclusions: High CRP values are associated with increased risk of hospitalization and/or death within 30 days among outpatients with AHD. Prospective evaluation of point-of-care CRP testing and whether real-time measurements can be used to risk stratify populations for interventions to reduce deaths is needed.

Poster Abstracts

1138 WITHDRAWN

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